Assessment of health status in a 20th century skeletal collection from the Western Cape

Alblas, Amanda (2019-04)

Thesis (PhD)--Stellenbosch University, 2019.

Thesis

ENGLISH ABSTRACT: Studies on the health status of skeletal remains give insight into the standard of living and survival pattern of historic populations. Analysis of trauma and pathological conditions in human skeletal remains are important in biological anthropology, explaining patterns of malnutrition, stress, disease and trauma in a population. However, the difficulty to overcome is the fact that the majority of skeletal pathological conditions are limited in their interpretive significance, since they are nonspecific and a range of stressors can cause the lesions. By analysing multiple conditions within a known population, pathological responses for specific insults can be outlined and in return help in interpretation of the frequencies and distributions within and between populations. The Kirsten Skeletal Collection, housed at Stellenbosch University, Division of Clinical Anatomy broadly represents individuals from mainly low socio-economic communities of different population groups in the Western Cape, dating throughout the 20th century. The aim of this study was to macroscopically and radiologically examine adult individuals (n=624, nmales=438, nfemales=186) in this collection for skeletal markings that included malnutrition (diet and metabolic deficiencies), osteoarthritic lesions, neoplasms, infective diseases and antemortem trauma lesions to be used as baseline information in further anthropological studies on the people of the Western Cape region. Statistically, the prevalence of specific diseases or trauma were correlated between the sexes, three different age-at-death and population groups as well as three different time periods throughout the 20th century using two-way frequency-tests and correspondence analyses. During the 20th century, many factors resulted in poverty, and "non white” people, namely the South African Black (SAB) and South African Coloured (SAC) population groups, was especially disadvantaged by the laws introduced by the ruling political party. The influx of people from rural areas during World War II to work in the manufacturing industry resulted in the already overcrowded, unsanitary informal settlements around the Cape Peninsula to be flooded, influencing the disease patterns in the communities. The results demonstrated that the lowest prevalence of metabolic deficiencies, iron deficiency anaemia (porotic hyperostosis), growth arrest signs (Harris’ lines), infections such as tuberculosis, osteomyelitis and non-specific periosteal reactions were observed in the South African White (SAW) population group. This confirms that higher socio economic societies, that escaped the unsanitary conditions associated with poor housing and overcrowding environments, were more succesfully buffering themselves from malnutrition and exposure to pathogens. Better dental health as well as dental fillings were also more associated with the SAW population group that had unrestrained access to dentists and health care facilities. In contrast, the ‘non-white’ population groups, that were supressed during the Apartheids regime, demonstrated a high prevalence of malnutrition, metabolic deficiencies, tuberculosis and trauma lesions. The difference between the higher and lower social categories was especially recognised during the late time period when the Apartheid laws of population group segregation among others, started to show results in the 1960 and 1970. Later, during the 1980s and 1990s, political unrest caused by the supressed majority, and the world due to the Apartheid laws, resulted in sanctions and lower economic opportunities for South Africa. A notable higher frequency of infective markings on bone was observed during the late time period in the study, an indication of the successful use of antibiotics during the last decades of the 20th century, which provided more time for lesions to manifest on bones due to the increased life-span of people. Studies on skeletal collections rely on the assumption that the remains represent a past community, population group or populations from a specific region and can be used as a valid comparative reference for reconstructing different aspects of skeletal biology of past people that lived in that population. The Kirsten Skeletal Collection represents adult age groups between 18 and 100, three population groups, both sexes, various time periods over the 20th century as well as known cause of death and last known residence. However, this skeletal collection relies on body donations or retention of adult unclaimed or family donated bodies under the statues of the Inspector of Anatomy, and therefore, resulted in a biased sample. This bias is perceived in the fact that the Kirsten Skeletal Collection have an overrepresentation of males, aged individuals and people with lower socio-economic status. Although three major South African population groups are represented, suggesting depiction in population variation, it is highly unequal, especially representing the overpresented heterogenous mixed population group (SAC) that lived in and around the northern townships of Cape Town. Despite limitations, in general this study of the Kirsten Skeletal Collection may represent many of the traits in the population at that time and may be useful in future studies on honours, masters and PhD level to refine region- and population specific reference data and play a supportive role in research and training of specialists. These data to be collected and interpreted in future studies, include estimation of demographic parameters (age, sex, ancestry origin) as well as human variation, trauma biomechanics and pathological conditions. If the existing predispositions of the collection are acknowledged and accounted for by the use of suitable methodology, the Kirsten Skeletal Collection holds much potential to become a valuable resource for future research projects in osteology and related fields.

AFRIKAANSE OPSOMMING: Studies oor die gesondheidstatus van skeletoorblyfsels gee insig in die lewenstandaarde en oorlewingspatrone van historiese bevolkings. In biologiese antropologie is die ontleding van trouma en patologiese toestande in menslike skelette belangrik, wat weer patrone van wanvoeding, stres, siekte en trouma in 'n bevolking verduidelik. Een struikelblok wat egter oorkom moet word, is dat die meerderheid patologiese toestande in die skelet moeilik is om te interpreteer, aangesien die tekens nie-spesifiek is en die letsels deur 'n verskeidenheid stressors veroorsaak kan word. Deur die ontleding van veelvuldige toestande binne 'n bekende populasie, kan patologiese reaksies vir spesifieke toestande verduidelik word, en dra dit by om die frekwensies en verspreiding daarvan binne en tussen bevolkings te interpreteer. Die Kirsten Skeletversameling word aan Stellenbosch Universiteit, in die Afdeling Kliniese Anatomie gehuisves, en verteenwoordig individue van verskillende bevolkingsgroepe wat veral uit swak sosio-ekonomiese gemeenskappe in die Wes-Kaap afkomstig is, en uit die 20ste eeu dateer. Die doel van hierdie studie was om die volwasse skelette in die versameling makroskopies en radiologies te ondersoek (n = 624, nmans = 438, nvrouens = 186) vir letsels weens wanvoeding (dieet en metaboliese tekorte), osteoartritiese letsels, neoplasmas, infektiewe siektes en antemortem trouma, wat as basislyn inligting gebruik word vir verdere antropologiese studies oor die inwoners van die Wes Kaapse streek. Statistiese analise (frekwensie-toetse) van die resultate is gekorreleer met die voorkoms van spesifieke siektes of trouma tussen geslagte, tussen drie verskillende ouderdoms- en bevolkingsgroepe, asook tussen drie verskillende tydperke wat oor die 20ste eeu strek. Baie faktore het ‘n invloed gehad op armoede gedurende die vroeë 20ste eeu en die ‘nie-blanke’ mense, naamlik die Suid-Afrikaanse Swart en Suid-Afrikaanse Kleurling groepe wat tydens die Apartheidsregering onderdruk is, was veral benadeel deur wette wat gedurende die 20ste eeu ingestel is. Die instroming van mense vanuit die plattelandse gebiede om in die vervaardigingsbedryf te werk gedurende die Tweede Wêreldoorlog, het daartoe gelei dat die reeds oorvol, onhigiëniese informele nedersettings rondom die Kaapse Skiereiland oorstroom was, en dus die siektepatrone beïnvloed het. Resultate het getoon dat die Suid-Afrikaanse wit populasiegroep die laagste voorkoms het van toestande soos metaboliese gebreke, ystertekort-anemie (porotiese hiperostose), tekens van groeiversteurings (Harris se lyne), infeksies soos tuberkulose en osteomiëlitis, en nie-spesifieke periosteale reaksies. Dit bevestig dat hoër sosio-ekonomiese groepe, wat uit die onhigiëniese toestande wat verband hou met swak behuising en oorbevolking ontsnap het, hulself meer suksesvol kon buffer teen wanvoeding en blootstelling aan patogene. Beter tandheelkundige gesondheid, sowel as tandheelkundige herstellings was ook meer geassosieer met die Suid-Afrikaanse wit populasiegroep wat onbeperkte toegang tot tandartse en gesondheidsorgfasiliteite gehad het. In teenstelling hiermee, het die 'nie-blanke' bevolkingsgroepe 'n hoë voorkoms van wanvoeding, metaboliese tekorte, tuberkulose en trouma getoon. Die verskil tussen die hoër - en laer sosiale kategorieë het veral na vore gekom in die laat tydsperiode toe, onder andere, rasse segregasie weens apartheidswette onder meer resultate in die 1960s en 1970s getoon het. Terselfdertyd het politieke onrus, veroorsaak deur die oorweldigende onderdrukte meerderheid en ‘n ontevrede wêreld weens die apartheidswette, sanksies en lae ekonomiese geleenthede vir Suid-Afrika tot gevolg gehad. Aan die ander kant is 'n noemenswaardige hoër frekwensie infeksieletsels gedurende die laat tydperk op been waargeneem, wat die gevolg was van die suksesvolle gebruik van antibiotika in die middel tot laat dekades van die 20ste eeu. Die letsels was ‘n aangeduiding dat die lewensduur van mense verleng is en dat daar dus meer tyd beskikbaar was vir letsels om op die skelet te manifesteer. Studies oor skeletversamelings maak staat op die veronderstelling dat die oorblyfsels 'n vorige gemeenskap, bevolkingsgroep of spesifieke streek verteenwoordig, en kan gebruik word as 'n geldige vergelykende verwysing vir die rekonstruksie van verskillende aspekte van skeletbiologie van persone wat voorheen in daardie populasie woonagtig was. Die Kirsten Skeletversameling verteenwoordig volwasse ouderdomsgroepe tussen 18 en 100, drie bevolkingsgroepe, beide geslagte, verskillende tydperke oor die 20ste eeu, asook bekende oorsaak van dood en die laaste beskikbare woonadres. Innames steun egter baie op liggaamskenkings, of die inname van volwasse onopgeëisde liggame en skenking van liggame deur familie, onder die beheer van die Inspekteur van Anatomie, en kan dus lei tot 'n ongelyke inname tussen populasiegroepe. Hierdie ongelykheid in inname word ook in die Kirsten Skeletversameling waargeneem, ten opsigte van die feit dat die versameling geen kinders bevat nie, en dat daar ‘n oorverteenwoordiging van manlike persone, bejaardes en persone vanaf ‘n laer sosio-ekonomiese omgewing is. Alhoewel drie groot Suid-Afrikaanse bevolkingsgroepe verteenwoordig word, wat wel bevolkingsvariasie verteenwoordig, is die getalle baie ongelyk, en dit verteenwoordig meestal die heterogene gemengde bevolkingsgroep (Kleurlinggroep) wat in en om die noordelike lae-behuisingswoonbuurte van Kaapstad gewoon het. Ons erken dat aansienlike beperkings bestaan, maar die algehele voorstelling van die Kirsten Skeletversameling spreek baie van die eienskappe aan en kan dus in toekomstige studies op honneurs-, meesters- en PhD-vlak gebruik word om streek- en populasie spesifieke verwysingsdata te verfyn en 'n ondersteunende rol in navorsing en opleiding van spesialiste te speel. Data wat ingesamel en geïnterpreteer kan word, sluit in die bepaling van demografiese parameters (ouderdom, geslag, herkoms), sowel as menslike variasie, trouma, biomeganika en patologiese toestande. Indien die bestaande ongelykhede van die versameling in ag geneem word en deur erkende metodiek gekorrigeer word, toon die Kirsten Skeletversameling die potensiaal om ‘n waardevolle bron van genoegsame navorsingsprojekte vir toekomstige navorsings in osteologie en relevante velde te bied.

Please refer to this item in SUNScholar by using the following persistent URL: http://hdl.handle.net/10019.1/106020
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